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Head & Neck Cancers Radiation Therapy

Depending on the type of head or neck cancer you have, your doctors may decide to use radiation therapy alone or in combination with other treatments. Radiation therapy (also called radiotherapy) uses high-energy radiation in the form of photons (such as X-rays) or subatomic particles (such as electrons, protons, or neutrons) to damage the DNA inside the cancer cells. When the DNA sustains enough damage, the cells cannot multiply, and they die. The goal of radiation therapy is to destroy as many cancer cells as possible with the least amount of damage to healthy cells.

As a Seattle Cancer Care Alliance (SCCA) patient, you will be cared for by radiation oncologists with specialized experience in treating head and neck cancers using state-of-the-art technology. Over the last decade there have been tremendous technical advances in head and neck radiotherapy. There are clinical studies testing newer strategies. Depending on the specifics of your cancer, your team may recommend one of several forms of treatment.

Intensity-Modulated Radiation Therapy

Intensity-modulated radiation therapy (IMRT) is one kind of three-dimensional conformal radiation therapy (3D-CRT). This treatment is designed so that the beam of radiation conforms closely to the size, shape, and contours of a patient’s tumor.

With IMRT, the beam can be split into smaller beams of different strengths. This helps the radiation oncology team deliver a higher dose of radiation to the tumor and lower doses to nearby healthy tissue. When IMRT is combined with image-guided radiation therapy (IGRT), very precise radiation therapy can be delivered to tumors while normal structures are spared.

Adaptive Radiation Therapy

Adaptive radiation therapy is the process of varying the radiation intensity according to changes in tumor dimensions during treatment. The goal is to cure the patient while minimizing side effects.

Proton Therapy

Proton therapy is an advanced therapy and an important alternative to standard X-ray (photon) radiation for many types of cancer (and some noncancerous tumors). Head and neck cancers are frequently located close to critical structures, such as the optic nerves, eyes, brain stem, and spinal cord. The advantage of using protons to treat these cancers is that doctors can target high radiation doses to the cancer while sparing sensitive structures nearby. As a result, proton therapy may reduce the likelihood of side effects, such as deterioration in vision or hearing, compared to standard X-ray radiation therapy.

Fast Neutron Therapy

Neutron therapy bombards cancer cells with neutrons. There are two advantages to using neutrons instead of photons or electrons. The first is that neutron beams are much more powerful. They deposit about 20 to 100 times as much energy into the target tissue as photon or electron radiation therapy does. The second is that neutron beams are more likely to damage both strands of a cancer cell’s DNA, rather than only one strand. This makes it harder for the cells to repair themselves and survive. Because neutron beams are so damaging, the risk of side effects is greater. For this reason, and because neutron beams tend to diffuse more, neutron therapy equipment includes many mechanisms designed to precisely focus and direct the beam and to protect surrounding tissue.

University of Washington Medical Center (UWMC) is the only place in the United States to offer neutron therapy, shown to be especially effective against salivary gland tumors, and doctors here are internationally recognized for their neutron therapy expertise. Each year about 100 people come from around the world for treatment using our unique Clinical Neutron Therapy System. About 80 percent of these patients have tumors of their major or minor salivary glands. We sometimes use neutron therapy to treat other cancers, including sarcomas, melanomas, and thyroid cancers, especially when surgery is not an option.

What to Expect If You Need Radiation Therapy

As an SCCA patient, you may have radiation therapy at one of several locations: the SCCA outpatient clinic on Lake Union, UWMC, SCCA Radiation Oncology at UW Medicine’s Northwest Hospital & Medical Center, or SCCA Proton Therapy.

No matter which location you use, you will start by meeting with your radiation therapy team, which will include a radiation oncologist and possibly a registered nurse, nutritionist, and social worker, to go over your treatment plan. About one month before radiation treatment begins, you will see a dentist to make sure your mouth is healthy, which helps prevent side effects from radiation that may make it difficult to eat, talk, and swallow.

Treatment with radiation therapy usually occurs daily over a period of several weeks, depending on the form of radiation therapy you are receiving.

Side Effects

Radiation therapy may cause side effects. These depend on the type and dose of the radiation and the part of the body being treated. Your team will give you details about which side effects to expect, how long they might last, and how you can manage them.

If you have radiation therapy to your head and neck area, you may experience redness, irritation, or sores in your mouth. Dry mouth and difficulty swallowing are common. Other side effects may include nausea; change in taste; loss of appetite; tooth decay; increased risk of cavities; sore, bleeding, or swollen gums; fatigue; or skin changes.

Let your team know about any side effects you experience. Your doctor may give you medicines to prevent or relieve them. For general advice, see the section on coping with side effects.

The time it takes to get over some side effects and regain energy depends on many factors, including your overall health and your treatment. Many side effects improve or go away after treatment is finished because your healthy cells recover over time.